197609362-3-27-2023-28-AS-MVAO-CWQVBN-20231018161748

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609362
Report Date: 03/27/2023
Date Signed: 03/27/2023 01:04:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/13/2023 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230213101346

FACILITY NAME:	HEIGHTS AT BURBANK, THE		FACILITY NUMBER:	197609362
ADMINISTRATOR:	DAWN SMITH		FACILITY TYPE:	740
ADDRESS:	2721 WILLOW STREET		TELEPHONE:	(818) 954-9500
CITY:	BURBANK	STATE: CA	ZIP CODE:	91505
CAPACITY:	130	CENSUS: 87	DATE:	03/27/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Dawn Smith		TIME COMPLETED:	01:04 PM

ALLEGATION(S):

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Staff allow resident to engage in unsanitary behavior

INVESTIGATION FINDINGS:

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On 03/27/2023 Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Agard was met by Dawn Smith, Administrator. LPA explained the purpose of this visit was to gather information, conduct interviews and deliver findings for this complaint.

The investigation consisted of the following: on 02/21/2023 LPA Agard initiated a complaint investigation. LPA toured the physical plant and requested records. The following records were requested: 1) staff roster, 2) resident roster, 3) needs and services plan for R1 and, 4) physician report for R1. All records were received at the time of visit.

Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230213101346

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: HEIGHTS AT BURBANK, THE	FACILITY NUMBER: 197609362
	VISIT DATE: 03/27/2023

NARRATIVE

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The investigation revealed the following: Regarding the allegation… “Staff allow resident to engage in unsanitary behavior.” It’s being alleged a resident is frequently able to roam throughout the facility covered in fecal material. LPA Agard interviewed 7 out of 78 staff in total. 2 out of 7 confirmed the allegation. S1 states, “yes there was one resident, they moved into our Assisted Living program but started having behaviors that were more becoming of a person with dementia. We never saw them carrying or handling their own feces. A resident reported that, but we never saw it.” S3 states, “a resident did report it to me, and I called a care staff right away to get them all cleaned up. I think the incident happened two times in the same day. The staff got to R1 right away both times. S6 states, “yes I know R1, there was a time when they put their hands in their pants and pulled out feces. I took them straight into their room.” All other staff interviewed denied the allegation. Citing not witnessing or hearing about it. During interviews with the residents, LPA Agard attempted interviews with 8 out of 87 residents. 0 out of 7 confirmed the allegation. R1 was unavailable for an interview. All residents unanimously denied the allegation. Citing never witnessing the allegation occur or not knowing the resident.

During the initial facility visit, LPA did not observe any residents walking around covered in fecal matter. LPA also did not observe the facility to smell of any fecal matter.

Based on LPA’s observation, and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) is/are unsubstantiated.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2023

LIC9099 (FAS) - (06/04)

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